Symptomatic coronary artery disease may be commonly due to significant atherosclerotic disease involving coronary vessels of relatively small caliber (i.e., with reference vessel diameter <2.75 mm). Whenever medical therapy fails and in other selected cases, revascularization by means of percutaneous coronary intervention (PCI) or bypass surgery is indicated even for small vessel coronary disease. However, despite the numerous developments and improvements in devices and techniques, PCI of small coronary vessels is still fraught with a significant risk of midterm restenosis after both balloon-only PCI and bare-metal stent implantation. Drug-eluting stents, especially those associated with very low angiographic late lumen loss (<0.20 mm), appear to significantly improve angiographic and clinical outcomes after PCI of small coronary vessels. The present article provides a concise and updated review on percutaneous coronary revascularization in patients with symptomatic small vessel coronary artery disease.